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Clin Microbiol Infect. 2018 Aug 2. pii: S1198-743X(18)30559-7. doi: 10.1016/j.cmi.2018.07.028. [Epub ahead of print]

Antimicrobial consumption and impact of antimicrobial stewardship programmes in long-term care facilities.

Author information

Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Italy. Electronic address:
Infectious Diseases Institute, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel.
Clinic of Infectious Diseases, University Hospital, University of Modena and Reggio Emilia, Modena, Italy.
Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy.
Internal Medicine and Rehabilitation Unit, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Infectious Diseases, Hospital Del Mar Medical Research Institute, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain.
University of Grenoble-Alpes and Clinic of Geriatrics, University Hospital of Grenoble-Alpes, Grenoble, France.
Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Division of Infection and Immunity, University College London, Gower Street, London, WCl E 68T, UK.
Long Term Care Facility "Pio Albergo Trivulzio", Milan, Italy.



Antimicrobials are among the most frequently prescribed drugs in long-term care facilities (LTCFs). Implementation of antimicrobial stewardship programmes (ASPs) is often challenging because of scarce data in this setting.


This narrative review aimed to provide data about antibiotic consumption in LTCFs and the need, implementation, and organization of ASPs in this setting.


PubMed was searched for studies assessing antimicrobial consumption and implementation of ASPs in LTCFs. The search was restricted to articles published in English in the last 10 years. Experts belonging to the ESCMID Study Group for Infections in the Elderly (ESGIE) reviewed the selected studies and evaluated the studies on ASPs according to the GRADE approach. Moreover, the quality of reporting has been assessed according to TREND and CONSORT checklists for quasi-experimental and cluster randomized clinical trials (cRCT), respectively.


Data on antibiotic consumption in LTCFs show great variability in LTCFs across and within countries. Reasons for this variability are difficult to analyse because of the differences in the types of LTCFs, their organization, and the population cared-for in the different LTCFs. However, studies show that the use of antibiotics among elderly patients in LTCFs, especially in cases of asymptomatic bacteriuria and influenza-like syndromes, is often inappropriate. High-quality cRCTs and low to moderate quality quasi-experimental studies show that educational interventions direct at nurse and physicians are effective in reducing unnecessary antibiotic prescriptions.


There is an urgent need for ASPs tailored for LTCFs. Multifaceted organized educational interventions, involving both clinicians and nursing staff, should be advocated and require institutional intervention by health authorities. Future studies assessing the impact of well-defined ASPs in LTCFs should produce compelling evidence in this setting.


Antimicrobial stewardship; Elderly; Inappropriate antimicrobial therapy; Long-term care facilities; Multidrug resistance


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